Job Description
JR139503 Genetic Counselor Reviewer The genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules. The GCR will collaborate with healthcare providers to promote the highest quality and efficient use of member benefits.
Location: This position will work remote and must live within 50 miles of one of our Pulse Point office locations.
How Will You Make An Impact - Receiving authorization requests for genetic tests from front-line intake. Conducting medical necessity review in adherence to guidelines and determining whether clinical information presented meets medical necessity criteria or requires physician review or override.
- Clearly and concisely documenting clinical review and other case interactions in online database in adherence to our standardized documentation style.
- Assisting physician reviewers with clinical interpretation questions regarding medical necessity of test requests.
- Addressing clinical questions received via incoming call from ordering providers and triaging calls when appropriate. Occasionally performing callouts to case submitters to obtain missing clinical information.
- Providing specific constructive feedback on Carelon guidelines.
- Maintaining confidentiality of patient and provider specific information.
- Contributing to team projects aimed to ensure case review accuracy and efficiency, such as updating case review processes, reporting issues, and creating internal case review resources.
Minimum Requirements - Requires MA/MS from an ACGC (Accreditation Counsel for Genetic Counseling) accredited program, and a minimum 3 years of experience in clinical genetics and/or diagnostic laboratory; or any combination of education and experience, which would provide an equivalent background.
- Active, unrestricted genetic counselor license is required in applicable states.
- ABGC (American Board of Genetic Counseling) board certification required.
Preferred Skills, Capabilities, And Experiences - Motivation to exceed departmental metrics.
- Active, unrestricted genetic counselor license, especially in Florida, Georgia, Indiana, and/or Kentucky.
- Experience in utilization management and/or reimbursement coding for genetic testing.
- Experience with somatic oncology testing a plus.
- Highly detailed-oriented.
- Escalates appropriate concerns or discrepancies.
- Works well both independently and as part of a team.
- Must be flexible and adaptable.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact
[email protected] for assistance.
Job Tags
Holiday work, Temporary work, Local area, Remote job, Flexible hours,